Dreamer323

Posted this in an old topic, but this should probably be its own topic. I was taking care of a patient that happened to have HIV, chronic Hepatitis C, and at least had Hepatitis B at one point. She accidentally gouged through my hand with her ridiculously long fingernails (I was wearing gloves) and at least removed a small portion of the epidermis (no blood that I saw, but I also didn't bleed it, unfortunately). I didn't know at the time that she had Hep C, possibly B, and didn't report it, thinking it would be considered a joke (and I didn't think it got in my blood, not so sure now). Having read some articles saying Hepatitis B at least can be on someone's fingernails, up to 72% according to this article, I am wondering if I should still report it, even a few days later. Would there be less chance of discipline with such a irregular exposure? Of course I have up-to-date Hep B vaccines, unsure about her. Too late for HIV PEP of course, but I probably could not have been convinced to use it with such a low risk scenario, even though she is HIV positive (not likely to have her blood all over her fingernails). Unfortunately she is from out of state and there was no idea what her viral load is, though she has been on antiretrovirals for at least a week straight. Also, how do you feel about not being told a pt's status? I probably would not have been wearing gloves if I hadn't known about the HIV, since I was only getting VS at the time. Another nurse I got report from was quite upset that he wasn't informed. I couldn't really find much information on transmission rates for this kind of thing, unsurprisingly. I certainly wish that discussion over patient's fingernails and disease transmission was a little more prominent than it is, I must say!

It's hard to believe that it has been almost a year since these incidents happened, and I have learned to be much more careful with every needle I work with, though I still have much to learn. No more of these incidents, but I did have something happen a few days ago.... I was taking care of my first HIV+ patient, who I found out later also has chronic hep C and, at least at one point, hep b (what are the chances). I was being as careful as I could with her, and was even wearing gloves for something as benign as vital signs. As it happens, she also had over an inch long fingernails (surely fake). When I was performing care, she accidentally gouged her fingernail into my hand, and caused an abrasion, at least removing the epidermis. I wasn't thinking clearly at the time to try and bleed the wound, so I can't say with certainty whether it reached the bloodstream. I washed it very thoroughly. I did not report it since I figured it would just be considered a joke, and wasn't certain it had reached my blood anyways. Not much chance of HIV transmission, unless she had been pulling an Elizabeth Bathory in a tub of her own blood before I came in the room, so I probably wouldn't have done the HIV PEP. I wished I had reported it so I could follow the Hep C--in this do you think I could get away with reporting it days later? I do feel that God has protected me from this like He did with the earlier incidents, but it's the fear of not knowing as well. Should I have taken the PEP, or would any of you? On another note, what might some of you feel about not knowing your pt's status for these conditions? If I didn't know about the HIV, I wouldn't have been wearing gloves for her VS, most likely. I sure wish I had known to be more cautious of fingernails, especially when they aren't intentionally trying to scratch you!

Yes, they do have safety locks, which did not help me in the first case. I hadn't gotten to use the safety lock yet on the second one. These are just the hours I have, not usually overtime every week, but of course long days with little break. I am also in the float pool, which means I have to be familiar with multiple floors and layouts, and can have a lot of patients in one day. I am also taking two BSN classes, getting paperwork ready for a practicum course, in a nurse residency program, and my wife and I have a baby on the way in about a month. I'll be switching to overnights in about a week too. I did see the pt had all her Heb B vaccines, as do I of course. Nothing of course about HIV, since I didn't report it, or labs for liver enzymes were available.

As above, I have had 2 needlestick injuries, both insulin needles, in 2 weeks. Stupid I know, I am about 2 months into orientation as a new nurse. The first one the safety cover was on all the way, I had 2 in my hands after administration, and was talking to about a million family members, and touched the end of it, somehow piercing skin. Negative for hep C and HIV. The second one, I was hurrying since I had 5 insulins to give in 30 minutes, again working almost 13 hours without a lunch break, and touched the end of it before I could get it to the container. I washed it right away, but did not report it this time, for fear of being fired. Now I am quite nervous since she is a LT dialysis pt, obese, end of life, mostly non-verbal. Would I likely be fired for reporting the second needlestick, even if it's less than 24 hours? Not sure that my health is worth a job that would fire me for this stupidity, even overworked stupidity.

Fear of being fired, ridiculed, ashamed to confront staff/patients, there are many obvious reasons. None of them being worth the risk of having a chronic and life-threatening disease, it's safe to say.